COMPARATIVE ANALYSIS OF DISSECTION TECHNIQUES IN POST-BARIATRIC ABDOMINOPLASTY

Introduction Post-bariatric abdominoplasty represents a critical reconstructive step for patients who have undergone massive weight loss. Despite its functional and aesthetic benefits, seroma remains one of the most frequent postoperative complications, often linked to tissue trauma and thermal damage during surgical dissection. Electrosurgery, while effective for hemostasis, can produce variable thermal effects depending on operating mode and contact medium. This study aimed to compare three dissection techniques—cutting mode, coagulation with dry gauze, and coagulation with saline-moistened gauze—in terms of drainage output, seroma incidence, and seroma volume after post-bariatric abdominoplasty. Methods A prospective observational study was conducted on 320 consecutive patients undergoing post-bariatric abdominoplasty performed by the same surgical team between 2023 and 2025. Subjects were divided into three groups according to the dissection technique: Group A (cutting mode), Group B (coagulation with dry gauze), and Group C (coagulation with saline-moistened gauze). All patients met inclusion criteria of weight stability for at least six months, BMI < 30 kg/m², and absence of major comorbidities. Data collected included postoperative drainage volume (24 h, 48 h, and total), incidence of clinically relevant seromas, and seroma volume in affected patients. Statistical analyses comprised ANOVA for continuous variables, Chi-square tests for categorical outcomes, and logistic regression to identify predictors of seroma formation. Results Significant differences were observed among the three groups. Group B showed the highest mean total drainage volume (210 ml) compared with Groups A (146.5 ml) and C (145 ml) (p < 0.001). The incidence of clinically relevant seromas was also greater in Group B (32%) than in Group A (20%) and Group C (11%) (p = 0.0008). Logistic regression confirmed surgical technique as an independent predictor of seroma development, while BMI, smoking, diabetes, and operative time were not statistically significant. Among patients who developed seromas, mean fluid volume was higher in Group B (58 ml) than in Groups A (41 ml) and C (45 ml). No significant differences were found regarding infection rate, wound dehiscence, or reoperation. Conclusion The findings demonstrate that the electrosurgical coagulation technique using dry gauze is associated with increased postoperative exudation and seroma formation, likely due to higher thermal injury and lymphatic disruption in subcutaneous tissue. Conversely, cutting mode and coagulation with saline-moistened gauze minimize heat diffusion and reduce seroma incidence. Incorporating cold saline as a contact medium represents a simple, cost-effective strategy to enhance safety and outcomes in post-bariatric abdominoplasty. Further randomized controlled trials with extended follow-up and ultrasound monitoring are warranted to validate these results and establish standardized dissection protocols.